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Reduced diffusing capacity for carbon monoxide predicts borderline pulmonary arterial pressure in patients with systemic sclerosis

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Title: Reduced diffusing capacity for carbon monoxide predicts borderline pulmonary arterial pressure in patients with systemic sclerosis
Authors: Ninagawa, Keita Browse this author
Kato, Masaru Browse this author →KAKEN DB
Nakamura, Hiroyuki Browse this author
Abe, Nobuya Browse this author
Kono, Michihito Browse this author →KAKEN DB
Fujieda, Yuichiro Browse this author →KAKEN DB
Oku, Kenji Browse this author →KAKEN DB
Yasuda, Shinsuke Browse this author →KAKEN DB
Ohira, Hiroshi Browse this author →KAKEN DB
Tsujino, Ichizo Browse this author →KAKEN DB
Atsumi, Tatsuya Browse this author →KAKEN DB
Keywords: Pulmonary arterial hypertension
Systemic sclerosis
Issue Date: Nov-2019
Publisher: Springer
Journal Title: Rheumatology international
Volume: 39
Issue: 11
Start Page: 1883
End Page: 1887
Publisher DOI: 10.1007/s00296-019-04370-0
Abstract: Early intervention in pulmonary arterial hypertension associated with systemic sclerosis (SSc) may improve its prognosis. We aimed to establish an algorithm to detect mean pulmonary artery pressure (mPAP) > 20 mmHg using non-invasive examinations in SSc patients by modifying the DETECT algorithm. This study included SSc patients who underwent right heart catheterization (RHC) in our hospital during 2010-2018. Following variables were assessed for performance to predict mPAP >= 25 mmHg or > 20 mmHg; anti-centromere or U1-RNP antibody, plasma BNP level, serum urate level, right axis deviation, forced vital capacity (FVC)/diffusing capacity for carbon monoxide (DLCO) ratio, and tricuspid regurgitation velocity. Of 58 patients enrolled in this study, 24 had mPAP of >= 25 mmHg and 9 had mPAP of 21-24 mmHg. Among variables tested, only FVC/DLCO elevated similarly in patients with mPAP of >= 25 mmHg (median 2.5) and those with mPAP of 21-24 mmHg (median 2.5) compared to those with mPAP of <= 20 mmHg (median 1.5). Given the particularly good correlation between DLCO and mPAP of > 20 mmHg, each variable was weighted according to its odds ratio and the total weighted score was calculated. The total weighted score exhibited a good predictive performance for mPAP of > 20 mmHg with its sensitivity of 87.5% and specificity of 92%. Among conventional risk factors for PAH, decreased DLCO may predict mPAP > 20 mmHg with priority in SSc patients. Weighting DLCO may improve the performance of screening algorithm for early SSc-PAH.
Rights: This is a post-peer-review, pre-copyedit version of an article published in Rheumatology international. The final authenticated version is available online at:
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 加藤 将

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